Provider Demographics
NPI:1235329129
Name:SWANSON, KEITH S (DDS)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:S
Last Name:SWANSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 NORMANDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-2700
Mailing Address - Country:US
Mailing Address - Phone:952-888-9661
Mailing Address - Fax:
Practice Address - Street 1:10700 NORMANDALE BLVD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55437-2700
Practice Address - Country:US
Practice Address - Phone:952-888-9661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7253122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist